Dr. Goldman Talks Mesh Removals

Dr. Howard Goldman, Cleveland Clinic

A woman who I am planning to do a Patient Profile on called me the other day. She had surgical mesh partially removed at the Cleveland Clinic with urologist, Dr. Howard Goldman, two weeks ago. She was on her way back to the Cleveland Clinic in extreme pain. She had been on the same antibiotic for two years and now had a high white cell blood count, she said. This woman’ didn’t sound good and cried on the phone but she refused to go to an emergency room because, she said, they didn’t know how to treat her.

I wanted to follow up with Dr. Goldman’s office to find out how he feels about partial mesh removals. Last week Dr. Goldman’s videos (here) featuring a partial mesh removal “excision” and a mesh “incision,” where the mesh is cut to relieve tension, shown on YouTube, made their way to MDND and many readers complained believing that contributes to a worse outcome. While some doctors who advocate full mesh removal would agree, Dr. Goldman says that’s not his experience.

MDND: Are partial removals the answer for mesh removal?

Dr. Howard Goldman: “We do removals specific to the area bothering the patient. Whether the mesh is extruded or exposed and is causing pain we remove what’s bothering her and we only try if it’s causing problem.

“As far as a total removal, I’ve seen patients ended up with major vascular or bowel issues and severe complications. If they have vaginal symptoms, we remove that portion and do not dig into their thigh. We do not want to make them worse.”

MDND: Do you not believe in the systemic response to mesh?

Dr. Goldman: “Mostly what we see are not systemic but localized symptoms. We have had a systemic response and we did go after more of it only in a specific situation. But if there is pain in an area or the mesh has eroded, we take care of that and they feel fine.”

MDND: Women I’m hearing from are are devastated and debilitated with pain all over. Some go to see Dr. Shlomo Raz at UCLA who is seeing patients all over the world for mesh removals.

Dr. Goldman: “You may be seeing the tip of the iceberg, the ones who are devastated and debilitated. In our paper which appears next month in the Journal of Urology, we looked at life after 20 odd vaginal mesh kits, and the vast majority had localized treatment and after three months and six months they did well. I’m well aware of Dr. Shlomo Raz and his thoughts and I’m well aware he is a great surgeon. I’m also aware that he’s a most vocal proponent of not using mesh. He was the most vocal proponent of using mesh.

“But we’re seeing a lot of women who have had more damage from the removal. People don’t realize the physicians have to have a lot of experience in this area.

MDND? What should you ask?

Dr. Goldman: How many have you done and completely taken out?

MDND: How many total removals do you do of the people who come in with complications?

Dr. Goldman: “We don’t have data but it’s not the majority, hardly any.”

MDND: Dr Donald Ostergard says mesh is not inert. See background story here. Do you agree?

Dr. Goldman: “It’s the same stuff that is used in vascular surgery; the same suture material. I can tell you among the slings, the vast majority are doing fine.”

MDND: How about the more mesh the more mess?

Dr. Goldman: “Were seeing a lot of technical issues – some surgeons without good outcomes.

“There is a paper from a few years ago – Ridgeway, B. is the first author, and in the new one the first author is Firoozi, F. Find it in PubMed to get the Abstract.

“The vast majority with localized treatment at the three-month and six-month follow-up did well. I’ve seen your site and I’d like to think you are seeing the tip of the iceberg, not to discount that some women are in really bad shape with serious problems.”

MDND: Any idea of the complication rate?

Dr. Goldman: “We know from a number of studies the pain, erosion and extrusion rates when compared to no mesh. We do need more data.” #

Learn More:

Journal of Urology, Purly Transvaginal/Perineal Management of Complications From Commercial Prolapse Kits Using a New Prostheses/Grafts Complication Classification System, March 14, 2012

During the study period of November 2006-2010, 23 women were followed after having transvaginal mesh from prolapsed kits removed after experiencing complications. The average age was 61 and the median period of time until complications was 10 months. Complications included pain, extrusion, incontinence, prolapse, perforation and urinary tract infection, “Purely transvaginal mesh excision appears to be safe with resolution of almost all presenting symptoms.”

Editors Note: It’s unclear from this article whether or not the mesh removal was complete or arms and anchors were left behind. *

I was the same way. I went to him and had 2 go back in a month bx it prolapsed again and some was hanging out. All he did was snip off the tip that hung out. Now skin has grown over it and my urethral prolapse is still there. I am shaped like u inside. I’m afraid to go back to him and other urogyns say they’ve seen worse and no one wants 2 touch another drs work. I sued mesh company and they want to settle for 35k. Seriously? For ruining my marriage, never being able to have unpainful sex ever again for the rest of my life, basically meaning i will never be able to have another relationship as long as I am alive and i am 40….along with recurrent bleeding, infections, random sharp pains like I am being cut, chronic illeosacral pain that ive been i PT for regularly for over 4yrs and having to wear an ileosacral belt 90% of the time? After lawyer fees, that 17k doesn’t even cover my last 7yrs of out of pocket maximums.

Dr. Goldman should wash his mouth out with soap! His nose must be about 6 feet long by now. Unbelieveable that a doctor at a “reputable” hospital like Cleveland Clinic should perpetuate such a barbaric procedure by saying “hardly any, not the majority”. What kind of data is that? And to say “some surgeons without good outcomes”, who is he to make that judgment? What does he know about a foreign body polymers? Blaming other doctors without knowledge of the science behind mesh as a medical device is irresponsible.

Dr. Goldman did surgery on mesh removal. He totally lied to my husband and I telling he removed all the mesh, and theres nothing else could be done. I still have the urethra sling totally in place and pieces of more mesh. Seems everytime I get a good reference for a doctor a few months later he gets on the bad list. I cant afford Californa or Texas. But wont go back to Goldman.

Saw your post and wanted to share this info. Dr Cohen or Dr Hibner are very good. If you have an attorney there is no out of pocket for the procedures, travel and accommodations. If you would like more information check out the web site or contact me directly by email.

Hi Iona here , I do have a Lawyer and have been notified that my TVT Boston Scientific Atvan. had been Red Flagged by FDA..I have had 2 Surgeries and am Still having Pelvic Pain , 2nd Prolayps ETC..Lawyers cant give me any Medical Advise…NEED HELP PLEASE

Yeah. I hear, and have read studies that say that. I know so many, and talk to them, that got worse after partial removal. I really believe that a partial removal affects the rest of the mesh. The force dynamics have to change – where once was tension, that has been removed. The pelvis is a very complicated part of the human anatomy, affect one part, and the rest of it responds. Put a “tension free” (what a crock – then how come it can be “too-tight”?) piece in this complex area and then expect it to stay in place. Movement has no effect at all? If you take a polypropylene ribbon, put it through a pillow in a loop and then cut it, what happen? The ribbon rebounds, no matter how small and even if you don’t move the pillow that much. How much more in the human body? I had a piece that hurt removed, and then it eroded into other areas. Several surgeries. It is very dangerous to just remove the one part of mesh. Ladies read, read, read and think. Many opinions out there. We’re guniea pigs. Better yet, skip this and use the old fashioned methods. P.S. I have another piece moving out about the size of a stitch. If you got a sliver, would your body keep it where it’s located – or try to move it back out? This is a foreign body. Sorry to rant, but this is so maddening!!!

I had the mesh surgery about 6 yrs ago with Dr. Walters. Have had nothing but troubles….UTIs, burning and frequency…..went back a number of times and all he would say is everything is ok…and gave me anti-spasmatic and antibiotics. Will not go back to him……heard Dr. Raz is the best from UCLA…

Hi Rosemarie~ yes generally he is considered the most likely to have a successful full mesh removal..It is a procedure he has perfected to the degree it is possible,,We just keep horror stories about partial removals, sort of schrapnel left after a partial some say. I do not quite understand the disconnect between docs who do partials such as at the Cleveland Clinic and patient outcomes. Do patients not come back complaining? What do the docs say? Thanks for writing and there is a waiting list for Dr. Raz if you are interested in going to him. ~ jwarm regards, ja

A very unfortunate choice of words: “tip of the iceberg”. Although he’s using this expression incorrectly, I think this phrase actually hits the nail on the head – this problem really is many times larger underneath than it appears to be on the surface.

To quote the freedictionary.com:

tip of the iceberg

n. pl. tips of the iceberg

A small evident part or aspect of something largely hidden: eg. “afraid that these few reported cases of the disease might only be the tip of the iceberg.”

My new friend went to ths Doctor and it was a disaster and she was so harmed by his partial removal. He promised her he could take some of the pain away. After the surgery she could barely walk, no longer work. After the surgery she developed a nasty infection she never had before. Not the level she had this time. He also was personally insulting to her. Told her that the smell (which she knew was infection) that she just needed to bathe more. She became bedridden over his help. He injured her all over again and now she must spend thousands of dollars to get proper medical care.

I have been searching for a eurogynecologist to remove my mesh, but after reading all of your testimonies about Dr. Goldman, I don’t think I would even consider going to the Cleveland Clinic. I contacted Dr. Moore’s office in Atlanta GEORGIA, and am waiting for a consultation with him. I hope to have the entire mesh removed if possible, because I have had too many medical complications arise after my 2009 implant, up to and including becoming disabled to work in July of 2009. I cannot even get any of the local doctors where I live to acknowledge that I am having mesh complications, up to and including the doctor that implanted it. I do know that if the doctor would have informed me of any possible complications, I would not have had this surgery done, and I definitely do not recommend this type of surgery to anybody that may be considering it for the future.

I’m so sorry to hear about your problem. Unfortunately it is not unusual. First the doctors put in the mesh. Patients either didn’t hear about the complications or they weren’t told. When they have problems, no one knows how many do, the doctor says “you’re the only one” and she walks away like there is something wrong with her. she is told to wait- it will get better. When it doesn’t she again feels like it’s her fault. Then the doctor, who doesn’t know what to do, sends her to pain management.

In what universe is this an appropriate outcome for a simple “minimally invasive” procedure?

The doctor did not explain how this procedure was done. For a long time, I didn’t know that he had implanted a mesh. In May of 2009 I started experiencing various medical conditions from my entire body aching, respitory/breathing problems, pain in my thighs that felt like it was in the femur bones, pain around my knee caps, and I began to walk with a limp. I dindn’t figure it out until I started seeing ads about mesh complications on TV. Then I started looking mesh complications up on the internet, and I found out sometime in 2010 that I had a gynecare tvt implanted. Then it all started to add up. Prior to surgery I had none of the complications that I came down with after surgery.

Dr. Mark Walters is who handled my mesh removal, Dr. Goldman repaired my urethra, So far I am happy with the results, though I am still in the healing phase. Dr. Walters has been fantastic, so please do not hesitate if you need someone in the Cleveland area!

Please women! Pay attention. .These guys will put this mesh into you because you let them..wake up!! If your ‘surgeon’ can’t do the correction the old fashioned non destructive way..GET ANOTHER SURGEON!

Just wanted to say…I consulted via email with both Dr Raz and his colleague, Dr Kim, regarding my sub-urethral sling that was eroding and causing bladder, vaginal and urethral pain. Because I have NOT had any groin or leg pain, both of them recommended a partial removal and advised the risk involved by trying to remove the meds that are embedded in the obturator muscle would be better avoided. I only am telling you this because it seems as though everyone considers Dr Raz the final word in mesh removal, yet his advice is apparently not always fir complete mesh removal. Proceed with caution by all means, but I think dismissing competent surgeons based solely on the belief that only complete removal is acceptable may be a mistake.

Only those of us that have or had polypropylene mesh in us know what our bodies go through.
My health will never be the same.
Mesh poisoned my immune system.
Even though I had a complete removal my body still hurts daily… Not the PAIN I was in for 3 years while it was in me but constant ache from head to toe.
So sad that we victims are not being listened to .

Can anyone update us as to how they are doing? My wife got a mesh put in a year ago and has groin pain still. Looking at what to do next but don’t want to make things worse. Any comments or direction is much appreciated.

I will say Dr Goldman saved my life. I underwent a very dangerous sling by AMS that was wrapped around my urethra. After four hours of surgery at Clevleland Clinic. Dr. Goldman and four other Doctors, that happened to be with him at the time. I never thought it would have been this bad. At the end after weeks of healing, I needed another surgery by Dr. Goldman. He is brilliant. If it were not for him I would have been either dead, or with a catheter for the rest of my life. I go for my yearly checkup. I pray all is still as it feels well.